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According to lead author Dr. Jennifer G. Robinson, a professor of epidemiology and director of the Prevention Intervention Center at the University of Iowa in Iowa City, the key may be targeting B lipoproteins in young and middle-aged adults.

These blood proteins (also called apolipoprotein B) include low-density lipoprotein (LDL), or the "bad," cholesterol. Scientists think that LDL and other B lipoproteins are among the leading causes of atherosclerosis.

Preventing atherosclerosis

"Lowering them may have a big impact on making atherosclerosis go away," says Dr. Robinson. "If this works, you could completely eliminate heart attacks and strokes within a generation, because you can't have a heart attack or stroke unless you have atherosclerosis."

The potential study aims to determine whether it is possible to reverse atherosclerosis in high-risk adults aged 25–55 using medications known as statins and PCSK9 inhibitors over a 3-year period. Both statins and PCSK9 inhibitors work to lower LDL cholesterol in the blood.

"The idea is to get the cholesterol very low for a short period of time, let all the early cholesterol buildup dissolve, and let the arteries heal," says Dr. Robinson, confirming that this method has been successful in animal studies. "Then patients might need to be re-treated every decade or two if the atherosclerosis begins to develop again."

"Once you know what causes something, you can come up with a hammer for it and eliminate it. We're not the first ones to think of this idea. This would be the culminating study of decades of research by thousands of people."

Dr. Jennifer G. Robinson

Dr. Robinson continues, "But I'm excited about this, and I think it's really time to pursue this hypothesis."

How atherosclerosis affects your health

Atherosclerosis, wherein plaque builds up in the arteries, can prevent oxygen-rich blood from traveling through the blood vessels to supply the rest of the body.

Plaque is made up of different substances in the blood, such as fat, cholesterol, and calcium. Over time, this plaque begins to harden, and when it does, it narrows the arteries.

This means that a person does not get as much oxygen-rich blood as they need, which can have serious consequences, including heart attacks and strokes. It can also lead to death.

There are some risk factors for atherosclerosis that people can try to control themselves, including unhealthy blood cholesterol levels. High levels of LDL and low levels of high-density lipoprotein, or "good," cholesterol are among the leading causes of the disease.

Other risk factors include high blood pressure, smoking, insulin resistance, diabetes, being overweight, and a lack of physical activity. An unhealthful diet can also be a factor, particularly for people who eat a lot of foods that are high in saturated fats, trans fats, cholesterol, sodium, and sugar.

Potential study limitations

A new way to combat early-onset atherosclerosis would be welcome, especially as heart disease is so widespread and a leading cause of death for people in the United States. The Centers for Disease Control and Prevention (CDC) note that about 1 in 4 deaths are a result of heart disease.

However, Dr. John Wilkins, a cardiologist and assistant professor at Northwestern University Feinberg School of Medicine in Chicago, IL — who has conducted studies on B lipoproteins but was not involved in this study — thinks that it might be difficult to convince healthy adults to take medications to keep atherosclerosis at bay.

He also notes that this type of clinical trial may be hard to do as it would involve tracking people for 20 or 30 years, which could prove difficult.

Overall, the study is promising, and as Dr. Robinson says, it could lead to big changes in how doctors and their patients fight heart disease in the future. Reducing or eliminating atherosclerosis in people is an excellent goal, and while a clinical trial has not started yet, it is definitely a good place to start.

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